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In England NowA Running Commentary by Peripatetic CorrespondentsI HAVE hit on a new method of stating the prognosis

of chronic dermatoses, and one which will not depressthe patient who gets a sight of his case-notes. It cameto me while I was taking the pulse of a fibrillating oldcrone in a Gloucestershire cottage. To while away theminute I admired some papillomatous remains on herwrist. " Ah," said she, " them’s the remains of MySkin Disease. It took nigh on a hunderdweight ofointment to cure tha’. Th’ old doctor brought it infower ounce pots at a time and I counted un." Thereit was in a nutshell and so simple. Subheadings may beadded according to colour or constituents of the ointmentwe think will be needed. Then when we write " Eczema,arm, 28 lb. pasta zinci co." it will add a new interestto our chronic cases to see whether we can keep to ourestimate.

* * *

The Bostonian had left Grand Central Terminal onlyfive minutes before, and I was enjoying the comfort andnovelty of modern railroad transport in America, whenthe sombre voice of the conductor on the loudspeakerdisturbed my reverie : " Will everyone please pay atten-tion now. If there is a doctor on this train will he pleasemeet me in the second car. There is a passenger beentaken seriously ill."

I was in no doubt what to do ; it was true that I wasunder a full-time contract with Mr. Bevan and I hadagreed not to indulge in private practice, but it wouldsurely be expected of me to help in an emergency, so Iresolved to leap forward from my comfortable blueupholstered seat and proudly introduce myself : " BritishLlledicine-at your service ! " So, swallowing my naturaldiffidence and the last mouthful of a Hershey almondbar, I proceeded up through the air-conditioned coach.praying that the emergency would not call for anyobstetrical skill. My fellow passengers displayed intenseinterest and smiled at me encouragingly. I could seethat they were proud of their fellow passenger. " Hopeyou find your patient not too bad, doctor," said one ofthem. A few yards up the same beautiful steel coachanother said, " Your patient is right here, doc." andjust opposite sat an agitated old lady. Beside her intears and wringing her hands was her anxious bespec-tacled daughter. A moment or two later our companyhad grown to include the conductor, a couple of train-men, the " ham sandwich, turkey sandwich, milk,peanuts, and ice-cold Coca-cola " vendor, a sick-bayattendant from the American navy, and a priest. Havinghinted to the last-named that his presence was thera-peutically unwise, I sat down beside my patient andasked her destination. When she replied " Providence "I was for recalling the priest had not the daughterchipped in, " Of course, doctor, we don’t need to go toProvidence, we can get off at New Haven ; don’t youthink it would be a good thing ? We could continue ourjourney tomorrow when mother is more settled."

I was confused at having momentarily forgotten theexistence of Rhode Island and its capital but once morereassured the willing priest that this was, after all, ajob for me. " Are you a real doctor ?

" asked the oldlady, as I held her wrist, noting a healthy pulse albeita tortuous artery. I assured her that not only was I areal doctor but that I had just that morning arrivedfrom England and that she was my first transatlanticpatient. " Do you mean to tell me," she added,

" thatyou are one of those Socialised physicians ? " " Yes," Isaid. " Then don’t they provide you with a bag? " sheasked, with obvious concern. I was about to explainthat as my specialty involved the conduct of autopsiesI seldom carried equipment around with me, when Inoticed a change in my patient evidently brought aboutby her interest in England. She was no longer agitated,her hyperventilating tendency had subsided, and she nolonger complained of the pain which had been " all overher chest and abdomen.My spot diagnosis of

" anxiety neurosis " was evidentlycorrect, and I knew that if I could eradicate the excitingcause of the attack-the daughter-we should all finishour journey in peace. " Don’t patients any longer have

to pay their doctors over there ? " she asked. " No," I

replied, " the service is entirely free," and then, correctingmyself, I explained how it was in fact so expensive thatpeople were determined to get their money’s worth out

* of it. " My mother is very interested," said the daughter,for she has paid many doctors bills’ in her 87 years of life."

"

The potential drama had now resolved itself into aninformal and amicable debate, in which neighbouringtravellers freely took part, on the merits and disadvan-tages of State medicine, when the conductor took measide and suggested quite rightly the exhibition of aplacebo. We retired together to the galley in the adjoininggrill car, and with the aid of the train-crew’s first-aid kitand a veritable dispensary in the daughter’s hold-all,we concocted a sedative which seemed likely to beeffective so long as the daughter was kept occupied. Iadvised continuing the journey to Providence.

Regular bulletins were brought to me in the grill carwhere I studied my first American menu with eageranticipation. The fashionable young sophomore oppositeleant over the remains of a sizzling Welsh rarebit withcrab salad to exclaim, " I’m right glad your patient isbetter, doctor ; it sure is a wonnerful profession." Inoticed that her attractively set toque remained undis-turbed as she drained her chocolate milk-shake. Thetrain-man came to find me and explained that in pursu-ance with regulations they had decided to call in thecompany’s disaster squad at New Haven. I realised nowthat they no longer had confidence in me because I hadno bag. The chicken pie still tasted good but I felt hurt.The railroad team was an impressive turnout ; how

could I compete with two ambulance drivers, three bags.and a stethoscope ? The company’s doctor rapidlyconfirmed my diagnosis and brewed a sedative whichquietened both ladies for the rest of the journey.On our arrival at Providence I was awakened by the

daughter. " You sure were wonnerful to mother and wewant to pay your fee," she said, fumbling with a tendollar bill in the upper reaches of her hand-bag. Iexplained that the humble services I had rendered couldbe regarded as an extension of the National HealthService Act, 1946. She thanked me cordially, wished mean enjoyable visit to the States, and remarked that shehoped they would never nationalise their doctors inAmerica because they liked to pay for their servicesindividually. I did not think that this view had-beenengendered in her by my doctoring, but I resolved tocarry my pyjamas and toothbrush for the rest of mystay in a doctor’s bag.

. * * * -

My peripatetic friend last week, who encounteredBessy at Christmas, had a bit of bad luck ; but at leasthe can console himself with the thought that he waswitnessing the effects of a rare bit of good luck on poorold Bessy. Speaking as an ex-problem-child (withnone of Bessy’s provocation) I congratulate her warmly,adenoids and all, for being able to keep up her spiritsin an atmosphere of powerful dislike. She may not bemuch cop, but lord ! you should have seen me in myheyday. At my most obnoxious I was frightened out ofmy wits by the vast enmity I provoked. I suppose ifBessy had had an eye or a leg missing she would havebeen better tolerated-and possibly more tolerable.But the poor girl has nothing to show the world but heradenoids.

* * *

At a recent meeting of my club-the M.R.C.P. Faileds-the new methods of conducting the examinationwere generally applauded. In our view the presence ofa younger man at the vivas helps to give confidence,and with two examiners a correct answer is unlikely tobe misinterpreted. But there were one or two criticisms.This is an expensive club, probably one of the mostexpensive in London, with an imposing entrance, and itseems a little unfair that the paying members have togo in by the tradesmen’s door through a corridor wherethe 600 or so of us form a scrum that makes the RugbyCup Final dwindle into insignificance. Can it be too thatthe distinguished Censors have been so long away fromphysiology as to forget the causes of frequency ? Fourstalls per 600 men under stress seems a little thin, and afeeling of urgency is not (repeat NOT) conducive to clearthinking.